Apparatus and method for closing a surgical site

ABSTRACT

A method of suturing an abdominal cavity includes inserting a spool of suture in the abdominal cavity. The method also includes capturing a first portion of the suture and removing the first portion from the abdominal cavity. The method also includes capturing a second portion of the suture and removing the second portion from the abdominal cavity. The method also includes tying the first portion to the second portion outside of the abdominal cavity.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional patent application of U.S. patentapplication Ser. No. 16/377,600, filed Apr. 8, 2019, which is a U.S.national counterpart application of international application serial No.PCT/US2018/045517, filed Aug. 7, 2018, which claims priority to U.S.Provisional Patent Application Ser. No. 62/672,085, filed May 16, 2018.The disclosures of each of U.S. patent application Ser. No. 16/377,600;PCT/US2018/045517; and U.S. Provisional Application Ser. No. 62/672,085are incorporated herein by reference in their entities.

TECHNICAL FIELD

The present disclosure relates to surgical instruments and particularly,to an instrument and method for closing a surgical site.

BACKGROUND

The fascial closure portion of any surgical case is critical. A wellpreformed minimally invasive surgery can result in a complication ifthis final portion of the case is neglected or done poorly. Anyabdominal wall defect greater than 8 mm should be accompanied by afascial closure to reduce the risk of incisional hernia. Incisionalhernias can be very costly complications. They lead to increasedhospital stays; increased patient pain and suffering; and most oftentimes an ensuing operation. Incisional hernias can also be life-treatingif the bowel becomes strangulated and ischemic. The rates of incisionalhernia have been alarmingly high in single incision minimally invasivetechniques and have prevented such techniques from becoming more widelyadapted as the standard of care.

The current technologies and devices for port site fascial closure areantiquated and require an immense amount of skill to use. Therefore, theresults are not widely reproducible even in the most talented hands. Theembodiments described herein will allow the integration of computeraided surgery (robotics) into the fascial closure portion of a case. Ascomputer aided surgery continues to progress, automation will becomemore accepted and adopted. With automation, surgery will become safer,more uniformly reproducible and efficient. This could potentially impactoverall patient outcomes, access to surgical care; and reduce overallcost by eliminating human error from the surgical suite. The disclosedembodiments will help continue the progression and widespreadintegration of single incision minimally invasive surgery and computeraided surgical techniques. Suture management is a problematic technicalskill for robotic surgeons in general surgical cases such as ventral andincisional hernia repair Suture management is crucial during roboticsurgeries of the GI tract and abdominal wall. An efficient management ofsuture can lower the cost of each case by reducing console and overalloperating room times. Currently, when the suture is introduced into therobotic surgical field, it is unorganized and tangled. The suture is atthe risk of knotting, breaking or incidentally being cut while it isbeing organized to begin closing a ventral defect or affixing a mesh tothe anterior abdominal wall. Sometimes to avoid this issue ofun-manageable suture, surgeons will reduce the length of the suture.This prevents difficulty with suture management but often contributes tomultiple lengths of suture introduced by an assistant throughout thecase. This practice can be time consuming. This practice can alsopotentially have a higher risk of a retained foreign body or incorrectcounts by using multiple needles to complete one case.

SUMMARY

The present disclosure includes one or more of the features recited inthe appended claims and/or the following features which, alone or in anycombination, may comprise patentable subject matter.

In one aspect of the disclosed embodiments, a device for assisting insuturing the fascial tissue after an abdominal surgery is provided. Thedevice could also be utilized during robotic intraabdominal, thoracicand pelvic surgery as a suture carriage. The device includes aclam-shell housing that retains a spool of suture. The loose end of thesuture is clamped and retained at an end of the device so that thesuture extends through an eyelet between the end and the spool. Thedevice is inserted into the abdomen through a surgical port. A suturegrabber is inserted through a guide ring and grabs the suture in theeyelet of the device. The grabber pulls the suture through the fascialtissue to form a first end to be tied. The grabber than grabs anotherportion of the suture and pulls a second end to be tied through thefascial tissue. The device and port are removed and the two ends aretied.

In another aspect of the disclosed embodiments, a suturing deviceincludes a clamshell body having a first side coupled to a second sideby a hinge. The first side and the second side each have a clamping endopposite the hinge. A slot is formed in each of the first side and thesecond side. The slot in the first side is aligned with the slot in thesecond side when the clamshell body is closed to form a cavity. A spoolis included having a rod extending from an end cap. The end cap isretained in the cavity and is rotatable relative to the clamshell body.A suture is wound around the rod of the spool. The clamping ends of thefirst side and the second side lock together to capture an end of thesuture.

In some embodiments, each of the first side and the second side mayinclude a first slot and a second slot. The first slots of the firstside and the second side may form a first cavity to retain a first endcap of the spool. The second slots of the first side and the second sidemay form a second cavity to retain a second end cap of the spool. Therod of the spool may extend between the first end cap and the second endcap.

In some embodiments, an eyelet may extend between the ends of the firstside. The suture may be accessible through the eyelet. An eyelet mayextend between the ends of the second side. The suture may be accessiblethrough the eyelet. An eyelet may be formed between the first side andthe second side when the first side and the second side are coupledtogether. The suture may be accessible through the eyelet.

In some embodiments, the suture may extend between the spool and theclamping end of the clamshell body. The clamshell body may be configuredto be retained by a robotic arm. The clamshell body may be sized to beextended through a trocar.

In some embodiments, a guide ring may be configured to couple to atrocar. The guide ring may be configured to receive a suture grabberthat grabs the suture in the clamshell body. The guide ring may includea conical sidewall extending between a first end and a second end. Theconical sidewall may be sized to position around a trocar. The first endof the guide ring may include a flange having a plurality of openings.The openings may be sized to receive a suture grabber. An openingdefined by the flange may be sized to position around a trocar. Theguide ring may include a first half and a second half that is separablefrom the first half. The first half may be coupled to the second half tocouple the guide ring to the trocar. A needle may be attached to an endof the suture for a hernia closure procedure.

In yet another aspect of the disclosed embodiments, a method of suturingan abdominal cavity includes inserting a spool of suture in theabdominal cavity. The method also includes capturing a first portion ofthe suture and removing the first portion from the abdominal cavity. Themethod also includes capturing a second portion of the suture andremoving the second portion from the abdominal cavity. The method alsoincludes tying the first portion to the second portion outside of theabdominal cavity.

In some embodiments, the spool may be retained in a clamshell body. Themethod may also include inserting the clamshell body into the abdominalcavity. The method may also include capturing the first portion of thesuture in an eyelet of the clamshell body. The method may also includecapturing the second portion of the suture in the eyelet of theclamshell body. The method may also include capturing the first portionof the suture and the second portion of the suture with a suturegrabber. The method may also include inserting the suture grabberthrough an opening of a guide ring.

The embodiments described herein can also be utilized during roboticintra-abdominal, thoracic and pelvic surgery as a suture and needlecarriage with immediate application in abdominal wall reconstruction andintra-corporeal anastomosis.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description particularly refers to the accompanying figuresin which:

FIG. 1 is a perspective view of an automated surgical system; FIG. 1A isa side perspective view of a surgical instrument that may be used withthe automated surgical system shown in FIG. 1 ;

FIG. 2 is a side elevation view of a spool of suture thread that is usedwith the surgical instrument;

FIG. 3 is a top plan view of the spool shown in FIG. 2 ;

FIG. 4 is a top plan view of the surgical instrument in an openconfiguration;

FIG. 5 is a bottom plan view of the surgical instrument shown in FIG. 4in the open configuration;

FIG. 6 is a side elevation view of the surgical instrument shown in FIG.4 in a partially open configuration;

FIG. 7 is a side elevation view of the surgical instrument shown in FIG.4 in a closed configuration;

FIG. 8 is a top plan view of the surgical instrument shown in FIG. 4 isa closed configuration;

FIG. 9 is a side elevation view of a guide ring in accordance with anembodiment;

FIG. 10 is a top plan view of the guide ring shown in FIG. 9 ;

FIG. 11 is a bottom plan view of the guide ring shown in FIG. 9 ;

FIG. 12 is a side perspective view of a half of the guide ring shown inFIG. 9 ;

FIG. 13 is a top plan view of the guide ring half shown in FIG. 12 ;

FIG. 14 is a side elevation view of a trocar inserted into a surgicalsite;

FIG. 15 is a side elevation view of the instrument shown in FIG. 4inserted through the trocar;

FIG. 16 is a side elevation view of the instrument rotated to a parallelconfiguration;

FIG. 17 is a side elevation view of a suture passer inserted through theguide ring and grabbing the suture in the instrument;

FIG. 18 is a side elevation view of the suture passer removing a segmentof the suture from the surgical site;

FIG. 19 is a side elevation view of the instrument rotated in thesurgical site;

FIG. 20 is a side elevation view of the suture passer inserted throughthe guide ring and grabbing another segment of the suture;

FIG. 21 is a side elevation view of the suture passer removing the othersegment of the suture from the surgical site;

FIG. 22 is a side elevation view of the suture being cut;

FIG. 23 is a side elevation view of the instrument rotated back to aperpendicular configuration.

FIG. 24 is a side elevation view of the instrument being removed throughthe trocar;

FIG. 25 is a side elevation view of the instrument and the arm removedfrom the trocar;

FIG. 26 is a side elevation view of the suture being tied to close thesurgical site;

FIG. 27 is a top view of a suture grabber passed through a firstaperture of the guide ring to pull a first half of a first suturethrough the guide ring;

FIG. 28 is a top view of a suture grabber passed through a secondaperture of the guide ring to pull a second half of the first suturethrough the guide ring;

FIG. 29 is a top view of a suture grabber passed through a thirdaperture of the guide ring to pull a first half of a second suturethrough the guide ring;

FIG. 30 is a top view of a suture grabber passed through a fourthaperture of the guide ring to pull a second half of the second suturethrough the guide ring;

FIG. 31 is a top view of the incision with the first and second suturesprepared to be tied;

FIG. 32 is a top view of a suture grabber passed through the firstaperture of the guide ring to pull a first half of a third suturethrough the guide ring;

FIG. 33 is a top view of a suture grabber passed through the secondaperture of the guide ring to pull a second half of the third suturethrough the guide ring;

FIG. 34 is a top view of a suture grabber passed through the thirdaperture of the guide ring to pull a first half of a fourth suturethrough the guide ring;

FIG. 35 is a top view of a suture grabber passed through the fourthaperture of the guide ring to pull a second half of the fourth suturethrough the guide ring; and

FIG. 36 is a top view of the incision with the first, second, third, andfourth sutures prepared to be tied.

DETAILED DESCRIPTION

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific exemplary embodimentsthereof have been shown by way of example in the drawings and willherein be described in detail. It should be understood, however, thatthere is no intent to limit the concepts of the present disclosure tothe particular forms disclosed, but on the contrary, the intention is tocover all modifications, equivalents, and alternatives falling withinthe spirit and scope of the invention as defined by the appended claims.

Referring to FIG. 1 , an automated surgery system 10 includes at leastone robotic arm 12 having a plurality of fingers 14 to grab surgicalinstruments. The robotic arm 12 is positioned at a surgical site so thatthe robotic arm 12 can manipulate the instruments at the surgical site.A control panel 20 includes a plurality of controls 22, e.g. a joystick,for a surgeon to manipulate the robotic arms 12 during surgery.

Referring to FIG. 1A, a suturing instrument 140 is configured to be usedwith the automated surgery system 10. In some embodiments, the suturinginstrument 140 is used manually and held by the surgeon using a manualarm. The suturing instrument 140 is configured to retain a spool 110 ofsuture thread 120. The suturing instrument 140 is positioned with asurgical site under the patient's skin and tissue. The suture thread 120is retained in an eyelet 162 of the suturing instrument 140 so that thesuture thread is accessible to be grabbed by another surgicalinstrument, i.e. a suture passer. The suture passer is inserted into thesurgical site and grabs a portion of the suture thread 120 positioned inthe surgical site. The suture thread 120 is then pulled out of thesurgical site with the suturing instrument 140 remaining is position inthe surgical site. The suturing instrument 140 is then rotated andpositioned for a second pass of the suture passer. The suture passergrabs a second portion of the suture thread 120 and pulls the secondportion from the surgical site so that two ends of the suture thread 120are positioned outside of the surgical site and a segment of the suturethread 120 between the two ends is positioned within the surgical site.The suturing instrument 140 can then be removed from the surgical sitewith the suture thread 120 is place. The ends of the suture thread 120are then tied together to close the surgical site. As set forth above,the suturing instrument 140 may be operated by the automated surgerysystem 10 or may be operated manually by the surgeon.

Referring to FIGS. 2-3 , a spool 110 includes a center post 112 and apair of ends 114 on each end of the center post 112. Each of the ends114 is circular so the spool 110 can roll or rotate on the ends 114. Theends 114 have a radius 116 that is greater than a radius 118 of thecenter post 112. The center post 112 is configured to retain a strand ofsuture thread 120. The strand of suture thread 120 is wound around thecenter post 112. A loose end 122 of the suture thread 120 extends fromthe center post 112 so that the loose end 122 can be grabbed to unwindthe strand of suture thread 120 from the center post 112.

Referring to FIG. 4 , a suturing instrument 140 is configured to retainthe spool 110 so that the spool 110 can rotate with respect to thedevice 140 to unwind the strand of suture 120. The suturing instrument140 includes a chassis 142 that is configured as a clamshell body. Thechassis 142 is created from a single piece of polymer. The chassis 142is designed with a hinge 144 to fold upon itself while encasing thespool 110 and locking the thread 120 in place. The chassis 142 includesa top end 146 and a bottom end 148 coupled to the top end 146 by thehinge 144. A body 150 of the top end 146 includes a pair of grooves 152that are each configured to retain one of the ends 114 of the spool 110so that the spool 110 rotates within the groove 152. A pair of arms 154extends from the body 150 to an end 164 that is formed by a pair ofangled arms 156 that join along a centerline 158 of the chassis 142. Astabilizing post 160 is positioned on each arm 154. An eyelet 162 isdefined between the arms 154, the arms 156 and the body 150. A length ofthe eyelet 162 can be variable depending on the robotic arm 12 used andthe best angles for fascial approximation. A body 170 of the bottom end148 includes a pair of grooves 184 that are each configured to retainone of the ends 114 of the spool 110 so that the spool 110 rotateswithin the groove 184. The grooves 184 are configured to align with thegrooves 152 when the chassis 142 is closed. A pair of arms 174 extendsfrom the body 170 to an end 176 that is formed by a pair of angled arms178 that join along the centerline 158 of the chassis 142. A stabilizingpost 180 is positioned on each arm 174 and is configured to align withthe stabilizing posts 160 when the chassis 142 is closed. An eyelet 182is defined between the arms 174, the arms 178 and the body 170. A lengthof the eyelet 182 can be variable depending on the robotic arm 12 usedand the best angles for fascial approximation.

Referring to FIG. 5 , the top end 146 includes a notch 190 that isconfigured to receive a finger 14 of a robotic arm 12 to retain thechassis 142 on the robotic arm 12. Likewise, the bottom end 148 includesa notch 192 that receives a finger 14 of a robotic arm 12 to retain thechassis 142 on the robotic arm 12. The chassis 142 is grabbed betweenthe fingers 14 of the robotic arm 12 so that the chassis 142 is retainedbetween the fingers 14. The chassis 142 has a depth 196, as illustratedin FIGS. 4-5 .

Referring to FIGS. 6-7 , the bodies 150 and 170 have angled walls 200that extend from the hinge 144. Another angled wall 202 extends fromeach angled wall 200. Outer walls 204 extend opposite the angled walls200 and 202. When the chassis 142 is closed, the outer walls 204 extendat an angle 210 with respect to the centerline 158 of the chassis 142.In some embodiments, the angle 210 is approximately 25°. The angledwalls 202 extend at an angle 212 relative to the centerline 158. In someembodiments, the angle 212 is approximately 35°. When closed, thechassis 142 has a height 198 that may be equal to the depth 196. Thestabilizing post 180 includes a tab 222 that inserts into an opening(not shown) of the stabilizing post 160 to secure the stabilizing post180 to the stabilizing post 160. Likewise, an end jaw 230 of the bottomend 148 includes a tab 232 that inserts into an opening (not shown)formed in an end jaw 234 of the top end 146 to secure the top end 146 tothe bottom end 148. The thread 120 extends from the spool 110 positionedbetween the bodies 150 and 170, between the stabilizing posts 160, 180,and to the end jaws 230 and 234. The loose end 122 of the thread 120 issecured between the end jaws 230 and 234 of the chassis 142. Asillustrated in FIG. 8 , the thread 120 extends through the eyelets 162,182 of the chassis 142.

The chassis 142 may be manufactured in various sizes to accommodatedifferent robotic arm 12 and port diameters. The chassis 142 can bedirectly grasped by an arm (either robotic or handheld) and inserteddirectly through a port site that will be closed. The suture type loadedon the spool 110 can be variable to account for different surgeonpreference. The suture 120 is loaded on spool and the end 122 is graspedwithin the end jaws 230, 234 of chassis 142. The end 122 is retained ina fixed position between the end jaws 230, 234, as shown in FIGS. 18-22. That is, FIGS. 18-22 show the suture 120 being pulled while the end122 of the suture 120 is retained in a fixed position between the endjaws 230, 234. The eyelets 162, 182 of the chassis 142 are designed tooptimize negative space while maintaining stability. This allows forample space for a suture passer to access the suture 120. Thestabilizing posts 160, 180 may be omitted if the material strengthallows. If omitted the suture 120 can be accessed from all 4 sides ofthe chassis 142 with a suture passer. The chassis 142 may bemanufactured with a needle on the end of the suture to allowintra-abdominal suturing.

Referring to FIG. 9 , a guide ring 250 includes a top end 300, a bottomend 302, and a sidewall 304 extending between the top end 300 and thebottom end 302. The guide ring 250 is made from a polymer and can bedisposable or re-useable. The sidewall 304 is frusto-conical in shapeand narrows from a top diameter 310 at the top end 300 to a bottomdiameter 312 at the bottom end 302. The guide ring 250 is sized toposition around a trocar 252 (described below). The guide ring 250 is aplastic ring that is affixed to the outside of the trocar 252. Referringto FIG. 10 , the top end 300 has a lip 254 that extends inward from thesidewall 304. A trocar aperture 320 is centered in the top end 300. Thelip 254 extends around the trocar aperture 320. The trocar aperture 320has a diameter 322 that is sized to be positioned around a trocar. Theguide ring 250 is designed with markings for optimal suture spacing forvarying sized trocars 252. The guide ring 250 can have markings thatline up with the skin incision or built in magnets to auto-orient to thearm's position within the patient. The lip 254 ensures that the dermiswill not be included in fascial closure. Suture passer apertures 262 arepositioned on the guide ring 250 on a rim of the lip 254. In theillustrated embodiment, the guide ring 250 includes four suture passerapertures 262. The suture passer apertures 262 are sized to receive thearm of a suture passer (described below). Referring to FIG. 11 , thebottom end 302 includes an exit aperture 340 that is sized to fit aroundthe trocar 252.

As seen in FIGS. 12-13 , the guide ring 250 includes two halves orhemi-guide rings 370. The hemi-guide rings 370 clip together to form theassembled guide ring 250. Each hemi-guide ring 370 includes a post 372extending from the lip 254. Each hemi-guide ring 370 also includes anopening 374 extending into the lip 254. The post 372 of a firsthemi-guide ring 370 is configured to insert into the opening 374 of asecond hemi-guide ring 370, and the post 372 of the second hemi-guidering 370 is configured to insert into the opening of the firsthemi-guide ring 370 to clip the first hemi-guide ring 370 to the secondhemi-guide ring 370 to form the guide ring 250. In use the hemi-guiderings 370 are clipped around the trocar 252 to position the guide ring250 onto the trocar 252.

FIGS. 14-26 illustrate a method for closing a surgical site utilizingthe instrument 140. Once the main critical portions of a minimallyinvasive surgical case are completed, the fascia must be closed (fortrocars >8 mm). An arm 240 (either computer aided arm or hand-helddisposable arm) is loaded with the first instrument 140. Anappropriately sized guide ring 250 is attached to the trocar 252 andpositioned with a lip 254 between the trocar 252 and the skin 260, asillustrated in FIG. 14 .

As illustrated in FIG. 15 , the instrument 140 is advanced into thetrocar 252 until full range of motion of the arm wrist is enabled. Theinstrument 140 is swiveled from a perpendicular position 286 to aparallel orientation in relation to the patient's fascial plane, asshown in FIG. 16 . This can be done with automation if computer aided;or under direct control by the surgeon if using a disposable arm. Basedon the size of defect being closed, the instrument 140 is rotated into afirst suture position 270 in correspondence to the guide ring markings.A suture passer 272 is advanced through a correlating aperture 274 onthe guide ring 250, as shown in FIG. 17 . The suture passer 272 can bedisposable or reusable. The suture passer 272 may have built in depthstops on the needle to prevent intra-abdominal injuries if passed byassistant. The suture passer 272 could be an external robotic arm andautomated.

The suture passer 272 enters the eyelets 162, 182 of the instrument 140and secures a segment 278 of the suture 120 so that the segment 278 canbe pulled out through the guide ring 250, as illustrated in FIG. 18 . Aclamp 280 is placed on the suture loop 288. In FIG. 19 , the instrument140 is rotated to a corresponding position 276 for a second throw. Thesuture passer 272 is advanced through a correlating aperture 282 on theguide ring 250, in FIG. 20 . The suture passer 272 grasps anothersegment 284 of the suture 120 and pulls the segment 284 of the suture120 back out through the correlating aperture 282 in the guide ring 250,in FIG. 21 . The suture 120 is allowed to be completely pulled off ofspool through the aperture. In FIG. 22 , the loop of the suture 120clamped. The suture 120 is then cut and held.

In FIG. 23 , the instrument 140 is rotated back to the perpendicularposition 286. In FIGS. 24-25 , the instrument 140 is removed from thesurgical site. The guide ring 250, the arm 240, and the trocar 252 areremoved and the suture 120 is tied using a surgeons knot in a normalfashion, as illustrated in FIG. 26 . If the defect is larger, theprocess is repeated for each suture 120 until the desired number ofsutures is placed. The sutures are always tied down after the trocar252, the arm 240, and the guide ring 250 have been removed from thepatient.

FIGS. 27-36 illustrate a method for utilizing the guide ring 250 duringthe procedure described above. The assembled guide ring 250 is placedaround the laparoscopic trocar 252 at the end of the operation. Thetrocar aperture 320 is oriented distal to the abdominal cavity and theexit aperture 340 is oriented proximal to the abdominal cavity. Thesidewall 304 of the guide ring 250 is thin and flexible yet strongenough to not be penetrated by the suture grabber 272. The sidewall 304terminates in the exit aperture 340. The exit aperture 340, when in use,is placed below the dermis in the incision. The suture passer apertures262 for the grabber 272 are located on the top end 300 of the guide ring250 outside the skin. The exit aperture 340 is on the bottom end 302 ofthe guide ring 250. The grabber 272 passes out of the guide ring 250through the exit aperture 340 between the trocar 252 and the bottom end302. An axis of orientation 400 is the line of the interfaces of thehemi-guide rings 370. A gamma (γ) angle is the angle between the axis oforientation 400 and a line of orientation 402. A gamma prime (γ′) is theangle between the axis of orientation 400 and a line of orientationprime 404. The gamma (γ) and gamma prime (γ′) angles are equal.

Initially, the guide ring 250 is aligned with the axis of the line oforientation 400 in parallel with the incision. The guide ring 250 isaligned as to pass the grabber 272 through the fascia opposite to theside of the incision in which it was inserted. After the instrument 170is inserted and parallel with the facia, the grabber 272 is insertedthrough an aperture 420 to retrieve suture 120. Once the suture 120 issecured, the grabber 272 is inserted into an aperture 422 and suture 120is re-grasped and pulled through. The instrument 170 is then changed andthe method is repeated for apertures 424 and 426 to form the sutureconfiguration shown in FIG. 31 .

Referring to FIGS. 32-36 , for even larger size trocar closures(e.g. >16 mm), the guide ring 250 position is dynamic to facilitatepositioning additional sutures 120 for fascial closure. The first twosutures 120 are passed through the fascia following the above sequence.A third instrument 170 is then inserted and aligned parallel with thefacia. The same sequence of grabber 272 passes are again made; however,before each pass is made, the corresponding guide ring line oforientation 402 is lined up in parallel to the incision before thegrabber 272 is passed into the corresponding apertures 420, 422, 424,426 in the guide ring 250. Repeating this method for each of theaperture 420, 422, 424, 426 positions produces four sutures in thefascia, as illustrated in FIG. 36 . The method can be extrapolated foreven larger defects or used to create a woven pattern of suture 120.

The suture grabber 272 may be automated to move with the guide ring 250and instrument 170 to optimize suture spacing. Alternatively, the suturegrabber 272 could be oriented manually by the surgeon. The instrument140 is compatible with a robotic arm (or a handheld device if a strictlylaparoscopic case). The method can be automated and observed with directsurgeon vision and override control at a console. This allows thesurgeon to tie the suture closure knot and close the skin once scrubbedin to close the patient. The instrument 140 can be used through thetrocar it is closing without removal of the trocar.

The spool 110 is a pre-loaded swiveling internal spool of suture thateliminates the steps of loading suture and passing it through theabdominal wall. The suture on the spool may be manufactured with aneedle for intra-abdominal suturing. The suture 120 is positionedreproducibly within the pertioneal cavity to ensure optimal suturespacing and tissue approximation leading to reduced incisional herniarates in larger (>20 mm) laparoscopic defects. This allows single portsite minimally invasive abdominal surgery to become more widespread andeventually the standard of care. Surgeons are able to guide an internalspool from the console while the bedside assistant can make safe,reliable passes under direct vision of the surgeon. Additionally, theguide ring 250 provides templates for optimal fascial suture spacing.

The instrument 140 is a disposable and there is potential for multiplesuture passes in each instrument 140. Defects would require oneinstrument 140 per 6-10 mm in trocar diameter to optimize closurestrength. The guide rings could be specifically manufactured for varyingdefect sizes. The instrument 140 can be scaled to fit varying sizes andbrands of robotic arms. Spools can be preloaded and sold in varyingpackage quantities.

The instrument 140 can be applied/modified to work in conjunction withcurrent and future computer aided surgical devices. The instrument 140allows the suture 120 to be within the peritoneal cavity. This offers amuch simpler design and method for closing fascia on a widespread scale.The instrument 140 is adaptable for future use with surgical artificialintelligence. The instrument 140 can be used by all specialties thatperform minimally invasive abdominal, thoracic or pelvic surgery. Theinstrument 140 can offer increased level of safety, precision, and easeof use.

In one aspect of the disclosed embodiments, a device for assisting insuturing the fascial tissue after an abdominal surgery is provided. Thedevice includes a clam-shell housing that retains a spool of suture. Theloose end of the suture is clamped and retained at an end of the deviceso that the suture extends through an eyelet between the end and thespool. The device is inserted into the abdomen through a surgical port.A suture grabber is inserted through a guide ring and grabs the suturein the eyelet of the device. The grabber pulls the suture through thefascial tissue to form a first end to be tied. The grabber than grabsanother portion of the suture and pulls a second end to be tied throughthe fascial tissue. The device and port are removed and the two ends aretied.

In another aspect of the disclosed embodiments, a suturing deviceincludes a clamshell body having a first side coupled to a second sideby a hinge. The first side and the second side each have a clamping endopposite the hinge. A slot is formed in each of the first side and thesecond side. The slot in the first side is aligned with the slot in thesecond side when the clamshell body is closed to form a cavity. A spoolis included having a rod extending from an end cap. The end cap isretained in the cavity and is rotatable relative to the clamshell body.A suture is wound around the rod of the spool. The clamping ends of thefirst side and the second side lock together to capture an end of thesuture.

In some embodiments, each of the first side and the second side mayinclude a first slot and a second slot. The first slots of the firstside and the second side may form a first cavity to retain a first endcap of the spool. The second slots of the first side and the second sidemay form a second cavity to retain a second end cap of the spool. Therod of the spool may extend between the first end cap and the second endcap.

In some embodiments, an eyelet may extend between the ends of the firstside. The suture may be accessible through the eyelet. An eyelet mayextend between the ends of the second side. The suture may be accessiblethrough the eyelet. An eyelet may be formed between the first side andthe second side when the first side and the second side are coupledtogether. The suture may be accessible through the eyelet.

In some embodiments, the suture may extend between the spool and theclamping end of the clamshell body. The clamshell body may be configuredto be retained by a robotic arm. The clamshell body may be sized to beextended through a trocar.

In some embodiments, a guide ring may be configured to couple to atrocar. The guide ring may be configured to receive a suture grabberthat grabs the suture in the clamshell body. The guide ring may includea conical sidewall extending between a first end and a second end. Theconical sidewall may be sized to position around a trocar. The first endof the guide ring may include a flange having a plurality of openings.The openings may be sized to receive a suture grabber. An openingdefined by the flange may be sized to position around a trocar. Theguide ring may include a first half and a second half that is separablefrom the first half. The first half may be coupled to the second half tocouple the guide ring to the trocar. A needle may be attached to an endof the suture for a hernia closure procedure.

In yet another aspect of the disclosed embodiments, a method of suturingan abdominal cavity includes inserting a spool of suture in theabdominal cavity. The method also includes capturing a first portion ofthe suture and removing the first portion from the abdominal cavity. Themethod also includes capturing a second portion of the suture andremoving the second portion from the abdominal cavity. The method alsoincludes tying the first portion to the second portion outside of theabdominal cavity.

In some embodiments, the spool may be retained in a clamshell body. Themethod may also include inserting the clamshell body into the abdominalcavity. The method may also include capturing the first portion of thesuture in an eyelet of the clamshell body. The method may also includecapturing the second portion of the suture in the eyelet of theclamshell body. The method may also include capturing the first portionof the suture and the second portion of the suture with a suturegrabber. The method may also include inserting the suture grabberthrough an opening of a guide ring.

Any theory, mechanism of operation, proof, or finding stated herein ismeant to further enhance understanding of principles of the presentdisclosure and is not intended to make the present disclosure in any waydependent upon such theory, mechanism of operation, illustrativeembodiment, proof, or finding. It should be understood that while theuse of the word preferable, preferably or preferred in the descriptionabove indicates that the feature so described can be more desirable, itnonetheless cannot be necessary and embodiments lacking the same can becontemplated as within the scope of the disclosure, that scope beingdefined by the claims that follow.

In reading the claims it is intended that when words such as “a,” “an,”“at least one,” “at least a portion” are used there is no intention tolimit the claim to only one item unless specifically stated to thecontrary in the claim. When the language “at least a portion” and/or “aportion” is used the item can include a portion and/or the entire itemunless specifically stated to the contrary.

It should be understood that only selected embodiments have been shownand described and that all possible alternatives, modifications,aspects, combinations, principles, variations, and equivalents that comewithin the spirit of the disclosure as defined herein or by any of thefollowing claims are desired to be protected. While embodiments of thedisclosure have been illustrated and described in detail in the drawingsand foregoing description, the same are to be considered as illustrativeand not intended to be exhaustive or to limit the disclosure to theprecise forms disclosed. Additional alternatives, modifications andvariations can be apparent to those skilled in the art. Also, whilemultiple inventive aspects and principles can have been presented, theyneed not be utilized in combination, and many combinations of aspectsand principles are possible in light of the various embodiments providedabove.

The invention claimed is:
 1. A method of suturing an abdominal cavity,the method comprising: attaching a spool of suture to a robotic arm;inserting the spool of suture in the abdominal cavity with the roboticarm, wherein the spool of suture is retained in a clamshell body and theclamshell body is inserted into the abdominal cavity in a closedconfiguration; capturing a first portion of the suture from theclamshell body with the clamshell body in the closed configuration andremoving the first portion from the abdominal cavity, wherein the firstportion of the suture is captured in an eyelet of the clamshell bodybetween the spool and a fixed end of the suture, wherein the fixed endof the suture is fixed between a pair of free ends of the clamshell bodypositioned opposite a hinge of the clamshell body; capturing a secondportion of the suture from the clamshell body with the clamshell body inthe closed configuration and removing the second portion from theabdominal cavity; and tying the first portion to the second portionoutside of the abdominal cavity.
 2. The method of claim 1, furthercomprising capturing the second portion of the suture in the eyelet ofthe clamshell body.
 3. The method of claim 2, wherein the second portionof the suture is captured between the fixed end and the first portion ofthe suture.
 4. The method of claim 2, further comprising capturing thefirst portion of the suture and the second portion of the suture with asuture grabber.
 5. The method of claim 4, further comprising insertingthe suture grabber through an opening of a guide ring.
 6. The method ofclaim 5, further comprising positioning the guide ring outside of theabdominal cavity.
 7. The method of claim 5, further comprising insertingthe suture grabber through a first opening of the guide ring to capturethe first portion.
 8. The method of claim 7, further comprisinginserting the suture grabber through a second opening of the guide ringto capture the second portion.
 9. A method of suturing an abdominalcavity, the method comprising: inserting a spool of suture in theabdominal cavity, wherein the spool of suture is retained in a clamshellbody and the clamshell body is inserted into the abdominal cavity in aclosed configuration; positioning a guide ring outside of the abdominalcavity; inserting a suture grabber through a first of a plurality ofopenings in the guide ring to capture a first portion of the suture fromthe clamshell body with the clamshell body in the closed configuration;removing the first portion from the abdominal cavity; inserting thesuture grabber through a second of the plurality of openings in theguide ring to capture a second portion of the suture from the clamshellbody with the clamshell body in the closed configuration; removing thesecond portion from the abdominal cavity; and tying the first portion tothe second portion outside of the abdominal cavity.
 10. The method ofclaim 9, further comprising capturing the first portion of the suture inan eyelet of the clamshell body.
 11. The method of claim 10, wherein thefirst portion of the suture is captured between the spool and a fixedend of the suture.
 12. The method of claim 11, wherein the fixed end ofthe suture is fixed between a pair of free ends of the clamshell bodypositioned opposite a hinge of the clamshell body.
 13. The method ofclaim 12, further comprising capturing the second portion of the suturein the eyelet of the clamshell body.
 14. The method of claim 13, whereinthe second portion of the suture is captured between the fixed end andthe first portion of the suture.
 15. The method of claim 9, furthercomprising inserting the suture grabber through a third opening of theplurality of openings of the guide ring to capture a third portion ofthe suture positioned between the spool and the second portion.
 16. Amethod of suturing an abdominal cavity, the method comprising: insertinga spool of suture in the abdominal cavity, wherein the spool is retainedin a clamshell body, the method further comprising inserting theclamshell body into the abdominal cavity; capturing a first portion ofthe suture and removing the first portion from the abdominal cavity,wherein the first portion of the suture is captured in an eyelet of theclamshell body, wherein the first portion of the suture is capturedbetween the spool and a fixed end of the suture, wherein the fixed endof the suture is fixed between a pair of free ends of the clamshell bodypositioned opposite a hinge of the clamshell body; capturing a secondportion of the suture and removing the second portion from the abdominalcavity; and tying the first portion to the second portion outside of theabdominal cavity.
 17. A method of suturing an abdominal cavity, themethod comprising: inserting a spool of suture in the abdominal cavity,wherein the spool is retained in a clamshell body, the method furthercomprising inserting the clamshell body into the abdominal cavity;positioning a guide ring outside of the abdominal cavity; inserting asuture grabber through a first of a plurality of openings in the guidering to capture a first portion of the suture, wherein the first portionof the suture is captured in an eyelet of the clamshell body, whereinthe first portion of the suture is captured between the spool and afixed end of the suture, wherein the fixed end of the suture is fixedbetween a pair of free ends of the clamshell body positioned opposite ahinge of the clamshell body; removing the first portion from theabdominal cavity; inserting the suture grabber through a second of theplurality of openings in the guide ring to capture a second portion ofthe suture; removing the second portion from the abdominal cavity; andtying the first portion to the second portion outside of the abdominalcavity.